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Evaluation of clinical outcomes in an interdisciplinary abdominal pain clinic: A retrospective, exploratory review

World Journal of Gastroenterology 2019年第24期25卷 3079-3090页

作者： amanda d deacy Craig A Friesen Vincent S Staggs Jennifer V Schurman division of Gastroenterology Children’s Mercy Kansas CityUMKC School of MedicineKansas CityMO 64108United States division of developmental and Behavioral Sciences Children’s Mercy Kansas CityUMKC School of MedicineKansas CityMO 64108United States Biostatistics and Epidemiology Health Services and Outcomes ResearchChildren’s Mercy Kansas CityUMKC School of MedicineKansas CityMO 64108United States

BACKGROUNd Pediatric functional gastrointestinal disorders(FGIds)are common and wellaccepted to be etiologically complex in terms of the contribution of biological,psychological,and social factors to symptom ***,despite its documented benefits,interdisciplinary treatment,designed to address all of these factors,for pediatric FGIds remains *** current study hypothesized that the majority of pediatric patients seen in an interdisciplinary abdominal pain clinic(APC)would demonstrate clinical resolution of symptoms during the study period and that specific psychosocial variables would be significantly predictive of GI symptom *** To evaluate outcomes with interdisciplinary treatment in pediatric patients with pain-related FGIds and identify patient characteristics that predicted clinical *** Participants were 392 children,ages 8-18[M=13.8;standard deviation(Sd)=2.7],seen between August 1,2013 and June 15,2016 in an interdisciplinary APC housed within the division of Gastroenterology in a medium-sized Midwestern children's *** be eligible,patients had to be 8 years of age or older and have had abdominal pain for≥8 wk at the time of initial *** and psychosocial data collected as part of standard of care were retrospectively reviewed and analyzed in the context of the observational *** regression was used to model odds of reporting vs never reporting improvement,as well as to differentiate rapid from slower *** Nearly 70%of patients followed during the study period achieved resolution on at least one of the employed outcome *** those who achieved resolution during follow up,43%to 49%did so by the first follow up(i.e.,within roughly 2 mo after initial evaluation and initiation of interdisciplinary treatment).Patient age,sleep,ease of relaxation,and depression all significantly predicted the likelihood of *** specifically,the odds of clinical resolution w

关键词： Pediatric functional gastrointestinal disorders Integrated care Behavioral health consultation Treatment outcomes Abdominal pain clinic

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Using quality improvement methods to increase use of pain prevention strategies for childhood vaccination

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World Journal of Clinical Pediatrics 2017年第1期6卷 81-88页

作者： Jennifer Verrill Schurman amanda d deacy Rebecca J Johnson Jolynn Parker Kristi Williams dustin Wallace Mark Connelly Lynn Anson Kevin Mroczka division of developmental and Behavioral Sciences Children's Mercy Primary Care Clinic Children’s Mercy division of General Academic Pediatrics Children’s Mercy Comprehensive Pain Management Children’s Mercy department of Pediatrics Children’s Mercy

AIM To increase evidence-based pain prevention strategy use during routine vaccinations in a pediatric primary care clinic using quality improvement *** Specific intervention strategies(i.e.,comfort positioning,nonnutritive sucking and sucrose analgesia,distraction) were identified,selected and introduced in three waves,using a Plan-do-Study-Act ***-wide change was measured from baseline to post-intervention by:(1) percent of vaccination visits during which an evidence-based pain prevention strategy was reported as being used; and(2) caregiver satisfaction ratings following the ***,self-reported staff and caregiver attitudes and beliefs about pain prevention were measured at baseline and 1-year post-intervention to assess for possible long-term cultural *** Significant improvements were noted *** of at least one pain prevention strategy was documented at 99% of patient visits and 94% of caregivers were satisfied or very satisfied with the pain prevention care ***/caregivers reported greater satisfaction with the specific pain prevention strategy used [t(143) = 2.50,P ≤ 0.05],as well as greater agreement that the pain prevention strategies used helped their children's pain [t(180) = 2.17,P ≤ 0.05] and that they would be willing to use the same strategy again in the future [t(179) = 3.26,P ≤ 0.001] as compared to *** and caregivers also demonstrated a shift in attitudes from baseline to 1-year ***,staff reported greater agreement that the pain felt from vaccinations can result in harmful effects [2.47 vs 3.10; t(70) =-2.11,P ≤ 0.05],less agreement that pain from vaccinations is "just part of the process" [3.94 vs 3.23; t(70) = 2.61,P ≤ 0.05],and less agreement that parents expect their children to experience pain during vaccinations [4.81 vs 4.38; t(69) = 2.24,P ≤ 0.05].Parents/caregivers reported more favorable attitudes about pain prevention st

关键词： Pediatrics Quality improvement distraction Pain management Immunization Vaccination Sucrose analgesia Pain prevention Non-nutritive sucking Comfort positioning Primary care

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